MEDICARE: ANDREW PAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	194251	CA

General Provider Information

NPI Number	:	1134700107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW PAK MD

Provider Business Mailing Address
First Line	:	2277 N GAREY AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2330
Country	:	US
Telephone Number	:	855-252-7223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2277 N GAREY AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2330
Country	:	US
Telephone Number	:	855-252-7223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	07/11/2025

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